Workgroup offers recommendations for more holistic health

The Advanced Health Models and Meaningful Use (MU) Workgroup presented its recommendations for helping address the holistic health of individuals during the June 30 Health IT Policy Committee meeting.

Workgroup chair Paul Tang, MD, MS, said in the effort to help healthcare go beyond traditional settings, the workgroup conducted a hearing to identify key opportunities and barriers for accelerating the adoption of advanced health models (AHMs).

During the hearing, participants said that nonclinical organizations are integral partners and highly motivated to share data, Tang said. However, sharing across clinical settings and social services is not very standardized and poorly incentivized.

AHMs are making substantial progress by making existing data actionable in new ways, but stakeholders also need seamless access to analytics capabilities to make these data useful. Some AHMs are responding to interoperability challenges by granting community organizations with access to a single platform, rather than realizing true interoperability across different systems, they found.

AHMs will need a data infrastructure that goes beyond EHRs, Tang said. “Mapping patient identities across datasets is very challenging without consistent patient identifiers. There are many AHM use cases that require only limited information about an individual, not the complete record. Stakeholders need tools that allow them to filter information so that only actionable information is transmitted, to avoid overwhelming the data recipient and to avoid unnecessary privacy risks.

There are about 9,000 different organizations but the “good news is we don’t have to spread the entire chart around,” Tang said. "Most organizations need limited information about an individual to better serve that individual. We wouldn’t want to inundate these organizations with a lot of data. That can get overwhelming and be counterproductive.”

The hearing participants also reported the lack of clarity around privacy and security issues raised by sharing information with non-HIPAA-covered community-based organizations which impedes data sharing and raises concerns about adequate protection of protected health information.

A shared longitudinal care plan is a critical concept for managing an individual’s health across a continuum that includes both clinical and nonclinical settings, according to the workgroup. But, community service organizations have varying levels of data support with their internal systems. And, a lack of standards for human social services impedes their use and integration with clinical systems.

Clarity around what exists would be very helpful, said Tang. “Information would move freely and safely if everyone had a better understanding of privacy and security.” Governance and privacy challenges for non-HIPAA covered entities are multiplied, he noted.

The workgroup recommended that the government promote greater standardization and usefulness of human services and clinical data across systems utilized by all health and service professionals, caregivers, individuals and their families.

Another recommendation is to promote greater standardization of social determinants and accelerate the implementation of dynamic, shared, longitudinal, care planning models that incorporate information from both clinical and non-clinical services and empower individuals to manage and inform their own health and care. “The group felt very passionately about this and think of it not so much as a care plan but as a plan for health.” They suggested that the Office of the National Coordinator for Health IT partner with a private foundation to convene relevant stakeholders in a working summit on dynamic shared care plans to identify the goals, enumerate the tasks needed to be completed and develop a strategy for accomplishing the work. Ideally, a public-private consortium would carry out the activities.

The workgroup also recommended provider clarifying guidance and dissemination of best practices related to sharing individuals’ data among HIPAA-covered entities and other community organizations. The Department of Health and Human Services should clarify through guidance and FAQs how existing statutes and regulations govern info-sharing activities, protect confidentiality and the role of the patient is in directing information to be exchanged.